- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,869.23 / $4,763.00 / $10,057.21
| Facility | | $1,869.23 | $4,763.00 | $10,057.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,514.89 / $1,752.53 / $2,834.39
| Professional | | $1,514.89 | $1,752.53 | $2,834.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,701.50 / $18,733.00 / $55,752.34
| Facility | | $7,701.50 | $18,733.00 | $55,752.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,602.07 / $2,060.11 / $3,426.30
| Professional | | $1,602.07 | $2,060.11 | $3,426.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,977.73 / $1,977.73
| Facility | | $900.00 | $1,977.73 | $1,977.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.74 / $2,473.70 / $3,785.45
| Professional | | $1,691.74 | $2,473.70 | $3,785.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $21,600.00
| Facility | | $4,505.00 | $10,133.00 | $21,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.10 / $2,157.73 / $3,705.59
| Professional | | $1,538.10 | $2,157.73 | $3,705.59 |